More than just words

More

than just

words....

Strategic Framework for Welsh Language Services in Health, Social Services and Social Care

Mae'r ddogfen yma hefyd ar gael yn Gymraeg. This document is also available in Welsh.

? Crown copyright 2016 WG28577 Digital ISBN 978 1 4734 6418 6

Annual Report ? Year 2

Contents

Part 1

Moving Forward

1

Health

1. Service planning and delivery (Objective 1)

2

2. Commissioning and the Active Offer (Objective 2)

3

3. Workforce Development (Objective 3) 4

4. Leadership (Objective 4) 5

5. Education, Learning and Development (Objective 5)

6

6. Strategies and Policies (Objective 6) 7

Part 2

Social Services and Social Care

1. Service Planning and delivery (Objective 1)

8

2. Commissioning and the Active Offer (Objective 2)

9

3. Workforce Development (Objective 3) 10

4. Leadership (Objective 4)11

5. Education, Learning and Development (Objective 5)

11

6. Strategies and Policies (Objective 6) 12

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Moving Forward

More than just words.... has been in operation for two years and will continue to be monitored until its 3 year action plans have come to an end. A follow-on framework has been published to build on the original More than just words.... and the monitoring system around the follow-on framework will be strengthened to provide a robust foundation to report on the implementation process and on progress made.

The first year's progress focused on developing processes that enabled service providers to offer bilingual service provision. Local health boards, trusts and social services providers used the first year to assess the language need in their areas and develop plans to provide services to meet these language needs.

Assessment of the progress made during this 2014/15 year has shown that the commitment to deliver the objectives of More than just words.... has resulted in a number of local initiatives being developed. Many of these have been recognised in the Welsh Language in Health, Social Services and Social Care Awards. Consequently, the aim going forward is to ensure these initiatives are implemented more widely.

The provision of services in Welsh is now a key component of the planning process for health and social services. In addition, the Welsh language is also a key element in the development of Welsh Government policy or service reconfiguration in the health and social services sectors. To that end, all policies pass through a Welsh Government Welsh language impact assessment to ensure that Welsh language needs are being met by new policy. These developments represent important progress in the successful implementation of More than just words.

However, despite examples of best practice across both sectors, there is still a lot of work to be done in ensuring the principles of More than just words.... are fully implemented by service providers. At the heart of More than just words.... is making changes to service provision that will permeate across the health and social services sectors and become a central part of the planning process.

The Active Offer is the most challenging aspect of More than just words.... and will continue to be challenging as we move into the third year of the strategic framework. The primary focus for year two of the strategic framework has been the delivery of the Active Offer principle, and although there are pockets of good practice across both sectors, there is yet to be a consistent or systematic approach to this.

Progress in year 2 has been monitored in line with the six strategic objectives set out in More than just words....

Strategic Objective 1: Strategic Objective 2: Strategic Objective 3: Strategic Objective 4:

Strategic Objective 5: Strategic Objective 6:

Implement a systematic approach to Welsh language services as an integral element of service planning and delivery.

To build on current best practice and plan, commission and provide care based on the Active Offer.

To increase the capability of the workforce to provide Welsh language services in priority areas and language awareness among all staff.

To create leaders who will foster a supportive ethos within organisations, so that Welsh-speaking users and carers receive language sensitive services as a natural part of their care.

To design and provide education, learning and development programmes which reflect the services' responsibility to plan and provide Welsh language services.

National strategies, policies and leadership.

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Part 1: Health

The seven local health boards and three trusts have a commitment to delivering the objectives of More than just words.... Year one of the strategic framework reported a number of changes to internal processes in order to provide a platform for further delivery. Evidence also demonstrated a number of successful projects:

1. Service planning and delivery (Objective 1)

In order to plan services to meet the needs of their communities, organisations need to ensure that their planning and commissioning systems include reference to the linguistic profile of their communities and ensure that this is reflected as they plan, commission and deliver services. In the first year, local health boards and trusts were required to have established the Welsh language profile of their communities and use this information as a baseline for planning local services. There is some evidence that organisations are actively using the linguistic profile of their communities when planning and providing services. In one trust, the community's linguistic profile is used as part of the recruitment process when recruiting frontline staff in the Welsh Blood Service. Others have evidence of having drawn up community profiles, but lack evidence of using these profiles sufficiently. There is some evidence that responding to Welsh language need has been taken into account as part of the latest round of Integrated Medium Term Plans (IMTPs) but the quality of this information is inconsistent from one organisation to another.

Year 2 achievement:

More health boards and trusts are using community profiles to inform the planning process and are increasingly recognising the importance of responding to Welsh language need in their IMTPs. In some trusts, the Welsh Language Scheme has been integrated into the tendering process and contractors have to comply with the Scheme requirements in order to meet the organisation's Welsh language policies. An increasing number of staff across health boards have completed their language skills field section on Electronic Staff Records (ESR) and in certain areas, this information is considered when reviewing rosters. Skills strategies have been developed in many areas with the aim of ensuring that the health boards will have enough staff recording their Welsh language skills on the ESR. This should increase significantly as staff have direct access to input their skills on ESR. The health boards' Welsh Language Champion at Board level ensures that all formal plans and reports have considered the impact on Welsh speakers. Work has also been done with the Community Partnership Development to ensure the Welsh language is mainstreamed into Contracting Checklists. Certain health boards supports 3rd sector and primary care contractors to deliver services bilingually via individual awareness sessions within GP surgeries and during 3rd sector induction programmes, as well as attending practice managers' meetings to raise awareness of More than just words.... and the Active Offer.

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Priorities for action:

ESR recording is inconsistent across health boards. The Welsh Government will be asking all health boards and trusts to encourage staff to complete the language skills field.

The information from the community profiles needs to be actively used in planning services. Evidence shows that this is already the case in some areas but not nationwide. Health boards are responsible for assessing the health and wellbeing needs of their populations, and planning and providing care to meet those needs.

The updated Welsh Government NHS planning framework and the recently-published primary care plan reinforces evidence that assessing local population needs and planning care is most effective when done for communities of around 25,000 to 100,000 people. Health boards are developing local community-level planning structures ? primary care clusters ? to support this. These clusters will be in a prime position to identify the Welsh language needs of individuals and local communities, helping primary care to respond more effectively to the principles set out in the Welsh Language (Wales) Measure 2011 and More than just words.....

2. Commissioning and the Active Offer (Objective 2)

This action is about mapping the capacity to provide the Active Offer; it is not about demonstrating that the Active Offer is being delivered across the sector.

Building on the progress made in the first year implementation of More than just words evidence suggests there are pockets of good practice in the delivery of the Active Offer and there are also examples of language data being used to identify the ability to provide the Active Offer. However, due to the lack of up-to-date and correct language data, there is no consistency across all health boards and trusts.

In order for this sector to be able to map the capacity to provide the Active Offer and ensure that `patients are empowered if they are able to speak to staff in their own language', the collection of language data needs to be made as accessible as possible. Changes to current internal systems and processes that enable this to happen must be a priority.

The theme of the Welsh Language in Health, Social Services and Social Care Conference and Awards held in July 2014 was the Active Offer. Delegates heard from the Consortium National de Formation en Sant? (CNFS) about how the Active Offer is used in the health sector in Canada so that both French and English speakers can access services in their language of choice. There was an opportunity to learn from the Canadian experience and share good practice. In addition a specific category on the Active Offer has been introduced as part of the awards.

Year 2 achievement:

Some health boards have developed their own Active Offer posters and staff information leaflets, and in many areas online resources are held on local intranet sites to assist with the delivery of the Active Offer. Discussions have been held with management teams in many areas with regard to mapping service user pathways and identifying opportunities along those pathways to make an Active Offer. In some areas, audits are undertaken of client records to identify whether they have received an Active Offer.

Welsh language versions of core dementia assessment tools have been developed and issued by Bangor University so that Welsh speakers can be assessed in Welsh.

The development of an Older People Mental Health project to map current provision and capacity to deliver the Active Offer within dementia services has been established. The service has also been gathering patient satisfaction views and this data will inform a specific patient-centred service.

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During staff and medical staff inductions sessions the Active Offer is often discussed and many areas have used St. David's Day and Diwrnod Shwmae/Su'mae to raise awareness of the Active Offer.

Language awareness training has been offered by a number of trusts for a number of years but in some areas the current training has now being updated to include information on the Welsh Language Standards and the integration of the Active Offer.

In some areas, audits are undertaken of client records where the call handler identifies that the preferred language is Welsh to ensure that the service continues to make the Active Offer.

Priorities for action:

Care in the Welsh language will be actively offered to patients. The Welsh Government will share examples of best practice which improve Welsh language service provision amongst staff and these examples of best practice will be replicated.

The Welsh Government resource on the Active Offer, published in 2015 will be utilised in staff training and development opportunities.

3. Workforce Development (Objective 3)

Implementing year two of More than just words.... has further highlighted the need for Welsh language skills investment across the local health boards and trusts. In order to ensure a language capable workforce and to increase the capacity of this workforce to use its language skills, the planning methodology has to ensure that language is a central element.

The evidence continues to demonstrate that although language skills are being collected (with some success), the information is yet to be used systematically in order to recruit for future posts. Language skills are not considered on parity with other skills.

Language skills strategies will enable the sector to address this issue systematically but ? to date - only four have been produced across the sector. There are a number of reasons for this and one of the most important is the collection of language skills as part of the Electronic Staff Record system.

The process for collecting this information continues to hinder the development of the language skills strategies and will need to be resolved if the local health boards and trusts are able to move forward with their language skills data analysis.

This was a priority set for the first year of the strategy and will continue to be a requirement as we move into year three of More than just words.....

Year 2 achievement:

Workforce and organisational development in certain areas have developed bilingual skills strategies. One of its aims is to ensure that the organisation will have an increasing number of staff recording their Welsh language skills on the Electronic Staff Record. As a result, the number of Welsh speakers on the database has increased.

In some areas, steps have been taken to mainstream the Welsh language into the recruitment process. Specific posts, such as call answering and tele-recruitment, have been identified as Welsh language essential.

In many areas, all new staff receive Welsh language awareness training as an integral part of corporate inductions. In addition, in some instances an online module is available via the intranet and Welsh language `buddy' schemes exists to help increase confidence of staff. Individual coaching is available for some senior staff.

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A Bilingual Skills Implementation Group has been established in one area and is chaired by the Assistant Director of Organisational Development. This group holds regular meetings to discuss Welsh language awareness provision.

Priorities for action:

The Welsh Government to ensure the process to collect the language skills of staff within the NHS is strengthened. This process will be initiated by the Welsh Government but delivered through the Directors of Workforce within the health boards and trusts. Careful consideration will be given about how to fill any skills gaps and the resources required. The Welsh Government will engage with NHS Wales to determine information available on the needs of Welsh speakers in different primary care settings and geographical locations. This work will inform what additional capacity may be required. For GPs, the primary care cluster work will enable GP practices to work together to ensure Welsh-speaking staff are available. The ultimate aim is to have more Welsh-speaking GPs. In the short term, the Welsh Government wants to ensure there are Welsh-speaking members of the primary care workforce available within the cluster area. Welsh Government officials are in the process of discussing with Community Pharmacy Wales the possibility of all Welsh-speaking community pharmacy staff wearing identifying badges ? many already do. Bilingual signage, which will include the NHS logo is being prepared for display in pharmacy premises. Further promotional material, such as patient information and service provision leaflets, will be introduced to enhance the patient experience for people who have Welsh as a first language. The Royal Pharmaceutical Society has already committed to investigating this, together with other specific initiatives relating to More than just words.....

4. Leadership (Objective 4)

Strong leadership and ownership of Welsh language services is vital so that local health boards' and trusts' responsibility for the language is mainstreamed into workforce and service planning. None have yet published a Welsh language strategic framework and action plan for the services they deliver, commission and contract which was a requirement in year 2. Some have commissioning plans in place for elderly people and learning disability sectors, where responding to language need is such an important element of providing quality and safe care. As well as more general language awareness courses for staff, there is a need to ensure that leadership training programmes include a strand on the importance of language sensitivity on the effectiveness of care, and that language is an integral element of care. However, while many have general courses for staff on the importance of the Welsh language in service delivery, there is nothing specific for leaders.

Year 2 achievement:

Welsh Language Champions report annually on service delivery as part of their annual progress reports against key Welsh Language Scheme and More than just words.... objectives. The Welsh language is clearly referenced within Integrated Medium Term Plans in most organisations and a policy statement published to describe compliance with More than just words.....

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Priorities for action:

Further commitment and leadership needs to be demonstrated by local health boards and trusts about the integration of ownership in relation to each action within More than just words This will ensure that individual Welsh Language Officers are not solely responsible for the delivery of the strategic framework.

The Welsh Government has produced an all-Wales Patient Experience Framework, which is intended to underpin health boards' annual quality statements. These are expected to reflect the experience of all people, including those who access healthcare in the Welsh language.

5. Education, Learning and Development (Objective 5)

There continues to be evidence provided of successful training programmes, including Welsh language awareness training programmes across the health sector.

The Coleg Cymraeg Cenedlaethol now has a significant number of lecturers who are developing Welsh language education and training in Healthcare.

In addition, a `Subject Panel' have been meeting once every academic term. The panel consists of lecturers which are supported by the Coleg Cymraeg Cenedlaethol and academics who are enthusiastic and supportive of Welsh language policy delivery. The panel agreed on action plans to increase the opportunities to study for students. In the last year, the subject panel have commissioned 5 specific projects to create educational resources to support the training. Project boards have been created to be responsible for identifying gaps and developing the necessary material to support purposeful provision of a high standard. It has been agreed that there will be a focus on the following themes: Human Sciences; Anatomy; Core Science; Ethics; Dignity; Communication; Consent; Legal Matters; the Active Offer and applicants have been asked to create relevant material.

Year 2 achievement:

Welsh language awareness sessions have been provided widely to internal staff including to staff in primary care and GP practice managers, and to some staff within GP practices.

Staff are increasingly encouraged at appraisals to identify any learning requirements, including Welsh language training. Welsh language awareness training is mandatory for all staff in some organisations. Welsh Language Awareness e-learning packages are available to assist with development. Education and training must be a key enabler in meeting the language needs of Welsh speakers in primary care.

One health board attended a Welsh Language Jobs Fair in Bangor University in March 2015, drawing the attention of prospective students to career opportunities within the health sector and demonstrating the Welsh language as an additional skill. Ysbyty Gwynedd's North Wales Clinical School also attend careers fairs in local secondary schools targeting Welsh-speaking pupils.

Priorities for action:

NHS Wales, in partnership with education commissioners and providers, should review the current arrangements and identify what further steps are required to deliver training programmes, which can reflect local needs.

There is further work to be done by the sector in ensuring that key partners such as Careers Wales and Job Centre Plus promote the importance and value of bilingual skills in the health sector. There is a consensus amongst academics that there is a need to engage with young people at an early stage to educate and inform them of job opportunities within healthcare and outline the benefits of bilingual skills.

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